Healthcare Provider Details

I. General information

NPI: 1609687219
Provider Name (Legal Business Name): PAOLA PREMUDA CONTI PH.D., CRC, CVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N HABANA AVE STE 401
TAMPA FL
33614-7119
US

IV. Provider business mailing address

6916 STONES THROW CIR N APT 9301
ST PETERSBURG FL
33710-4768
US

V. Phone/Fax

Practice location:
  • Phone: 888-666-3089
  • Fax: 888-666-9870
Mailing address:
  • Phone: 334-350-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCRC112478
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: